The private-public debate is a distraction from health care’s real problems

Like clockwork, every time Canadian health care goes through a rough patch, we see the same response.

Certain politicians and pundits will declare that, given the gravity of the situation, we need a “bold solution” and offer up privatizing some health services as the solution.

No sooner will the words be uttered than activists and union leaders will declare that “the future of medicare is in peril.”

Eventually, the politicians will do next to nothing – maybe announce a pilot project – and the defenders of medicare will declare victory once again against the evils of privatization.

Meanwhile, access to health care services will grow a little worse, waits will grow a little longer, and costs will continue to rise.

Ontario to boost private clinic surgeries, move elderly patients to long-term care to ease hospital strain

Imagine if, instead of embarking on this rhetorical merry-go-round, we actually did something radically pragmatic and recognized, as a starting point, that there is a role for both public and private funding and delivery in health care, but neither is a panacea.

Surely, there is almost universal agreement that no insurance plan, public or private, can cover all the health needs/wants of every person, right down to the last Aspirin.

There is probably even consensus that there are things the private sector does better, such as building hospitals and manufacturing drugs, and things the public sector excels at, such as training workers and delivering public-health programs.

It might even be useful to remind ourselves that the role of publicly funded health insurance (medicare) is to ensure that no Canadian is denied essential health services because of an inability to pay.

In other words, there are, by definition, some non-essential health services.

So instead of the dichotomous, “private bad/good, public good/bad” blandishments, would we not be better served using our energies to determine the ideal mix of public-private funding and delivery, and the appropriate roles for government, business, workers, patients and taxpayers?

There is likely no perfect formula, but we definitely don’t have the mix right now.

Time and time again, at both ends of the spectrum, we see European and Nordic countries held up as examples of the superiority of public or private spending and delivery.

Germany has better health care because it has extensive private health insurance; the Netherlands has a better public-health system because it offers extensive coverage of prescription drugs; France doesn’t have long wait lists because it allows surgeons to practise in both public hospitals and private clinics; Denmark has the best eldercare because it offers home care and long-term care universally; and so on.

When we try to cherry-pick solutions from other jurisdictions, we ignore the larger political and cultural context.

The reality is that every country with universal coverage of essential health services, including Canada, has a mix of public and private funding and delivery to fulfill that promise.

Nobody cares if the health services they receive are delivered and paid for publicly or privately; they care about timely access, affordability and quality. They have to be the focus.

What European and Nordic countries do differently than Canada (in addition to spending more on social welfare than on sickness care) is: 1) clearly delineate which health services are covered by the state and which are not; 2) strictly regulate the public-private fault lines so that care is delivered in an equitable and affordable manner, regardless of whether services are offered publicly, privately or both.

In Canada, on the other hand, we have the worst of both worlds: a largely unaccountable public system, and an almost-not-regulated private system.

Worse yet, we pretend that simplistic approaches such as “more private delivery” or “more public funding” will magically solve everything when the real problem in Canada is that the health system isn’t a system, but rather a series of unconnected services that often work at cross purposes, and with an almost total lack of oversight and planning.

The current crisis – grave staffing shortages – is a case in point. We’ve known for years, if not decades, that this problem was coming, given the demographics of the aging work force.

Yet, there is no health human-resource plan. Provinces simply pilfer workers from each other, and then, when they’ve exhausted that approach, look to countries like the Philippines for workers.

That constant lurching from crisis to crisis with no plan, and no vision, is the real problem we need to address in Canadian health care.

The so-called private-public “debate” is the least of our worries. Rather, it’s a tiresome and costly distraction from the real problems that need to be addressed.

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